Diagnosis of severe scrub typhus infection by next-generation sequencing:a case report

Abstract

Background: Scrub typhus is an acute febrile illness, which was caused by Orientia tsutsugamushi and transmitted through the bite of chiggers. The diagnosis of scrub typhus could be missed diagnosis due to the absence of the pathognomonic eschar. Case presentation: A 76-year-old man was hospitalized with fever and kidney injury and was diagnosed of hemorrhagic fever with renal syndrome first. However, the situation of the illness deteriorated into refractory septic shock and multiple organ dysfunction rapidly,although the treatment of anti-sepsis was used in 3rd-5th day. Orientia tsutsugamushi was determined to be the causative pathogen by Next-generation sequencing of his plasma sample in 6th day. Then, the patient was treated with doxycycline and azithromycin and recovered quickly. Conclusions: Next-generation sequencing was a new diagnostic technology and could identify scrub typhus in accurately and fast without the pathognomonic eschar.

Diagnosis of Coxiella burnetii infection via metagenomic next-generation sequencing: a case report

“…Metagenomic analysis has been used to diagnose the causes of many diseases with negative blood cultures or negative cultures of infected sites [ 8 – 10 ]. mNGS can realize the screening of most infectious pathogens and it has been used in the diagnosis of other pathogens such as Orientia tsutsugamushi [ 11 ], Parvimonas micra [ 12 ] etc. In this case, Coxiella burnetii was determined to be the causative pathogen by mNGS (non targeted metagenomics was performed not 16S targeted metagenomics) for Q fever.…”

Successful diagnosis and treatment of scrub typhus associated with haemophagocytic lymphohistiocytosis and multiple organ dysfunction syndrome: A case report and literature review

“…With this technology, DNA fragments can be sequenced from a clinical specimen. However, to date, there is few cases of scrub typhus have been confirmed using mNGS [ 22 , 23 , 24 , 25 , 26 , 27 ]. Li et al.…”

Scrub typhus diagnostics: An overview

“…Recently, next generation sequencing (NGS) performed on clinical samples, metagenomic NGS (mNGS) has been used for identifying the etiology when conventional techniques have been unable to unravel the pathogen. NGS on various biological samples has been successfully performed to detect Orientia tsutsugamushi (98)(99)(100)(101)(102)(103). The summary of the cases for which NGS was used is described in the following paragraph.…”

“…NGS detected Orientia tsutsugamushi (317 reads) in plasma on day 16 of illness in a 76-year old Chinese patient with fever, kidney injury who was eschar negative. The plasma PCR performed subsequently, was positive (100). A 51 year old female farmer from Guangzhou (an ST endemic area), was diagnosed by NGS on 12th day of fever as ST (377 reads) followed by PCR confirmation, (101).…”